Method and system for preventing sore throat in humans

ABSTRACT

A method and system to prevent sore throat infections in humans includes the administration of an active ingredient to a site on the mucus membranes of the throat of a human that inhibits adherence and promotes desorption of  S. pyogenes  to soft tissue surfaces, such as the pharyngeal and oral mucosa of a human. A mucoadhesive strip having a surface topography that resists bioadhesion of undesired bacteria that are typically present in a human&#39;s mouth is preferably employed and that has one or more encapsulated agents selected from the group consisting of an antibiotic; lactic acid bacteria;  S. pyogenes  modified by a CRISPR-Cas system to reduce one or more virulence factors; and a breath mint solution.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/385,278, filed Dec. 20, 2016 (now U.S. Pat. No. 10/085,938, issuesOct. 2, 2018), which seeks priority from U.S. Provisional PatentApplication Ser. No. 62/387,404.

This application is a continuation-in-part application of U.S. patentapplication Ser. No. 14/752,192 filed Jun. 26, 2015 (now U.S. Pat. No.9,549,842, issued Jan. 24, 2017), which is a continuation-in-partapplication of U.S. patent application Ser. No. 14/225,503 filed Mar.26, 2014, (now issued U.S. Pat. No. 9,445,936, issued Sep. 20, 2016),which is a continuation of U.S. patent application Ser. No. 13/367,052,filed Feb. 6, 2012 (now issued U.S. Pat. No. 8,701,671, issuing on Apr.22, 2014), which claims priority of U.S. Provisional Patent ApplicationSer. No. 61/439,652, filed on Feb. 4, 2011 and U.S. Provisional PatentApplication Ser. No. 61/556,023, filed on Nov. 4, 2011.

This application also is a continuation-in-part application of U.S.patent application Ser. No. 15/270,034, filed Sep. 20, 2016 (now U.S.Pat. No. 9,750,802, issued Sep. 5, 2017), which is acontinuation-in-part application of U.S. patent application Ser. No.14/954,074, filed on Nov. 30, 2015 (now issued U.S. Pat. No. 9,457,077,issuing on Oct. 4, 2016), which is a continuation-in-part application ofU.S. patent application Ser. No. 14/574,517, filed on Dec. 18, 2014 (nowissued U.S. Pat. No. 9,408,880, issuing on Aug. 9, 2016), which claimspriority of U.S. Provisional Patent Application Ser. Nos. 62/072,476,filed on Oct. 30, 2014; 62/053,926, filed on Sep. 23, 2014; 62/014,855,filed on Jun. 20, 2014; and 61/919,297, filed on Dec. 20, 2013.

This application is also a continuation-in-part application of U.S.patent application Ser. No. 15/228,454, filed Aug. 4, 2016 (now U.S.Pat. No. 9,585,920, issued Mar. 7, 2017).

This application claims priority of U.S. Provisional Patent ApplicationSer. Nos. 62/387,405, filed Dec. 24, 2015; 62/274,550, filed Jan. 5,2016; and 62/275,341, filed Jan. 6, 2016.

This application is also a continuation-in-part application of U.S.patent application Ser. No. 14/611,458, filed Feb. 2, 2015, which is acontinuation-in-part application of U.S. patent application Ser. No.14/502,097, filed Sep. 30, 2014 (now issued U.S. Pat. No. 9,010,340,issuing on Apr. 21, 2015), which is a continuation of U.S. patentapplication Ser. No. 14,307,651, filed on Jun. 18, 2014 (now issued U.S.Pat. No. 8,936,030, issuing Jan. 20, 2015), which is acontinuation-in-part application of U.S. patent application Ser. No.14/079,054, filed Nov. 13, 2013 (now issued U.S. Pat. No. 8,757,173,issuing on Jun. 24, 2014), which is a continuation of U.S. patentapplication Ser. No. 13/425,913. filed Mar. 21, 2012 (now issued U.S.Pat. No. 8,584,685, issuing on Nov. 19, 2013), and claims priority ofU.S. Provisional Patent Application Ser. No. 61/467,767, filed Mar. 25,2011.

The entire disclosure of the prior applications are considered to bepart of the disclosure of the accompanying application and are herebyincorporated by reference

FIELD OF THE INVENTION

The present invention is directed to a method and system to prevent sorethroat infections in humans.

BACKGROUND OF THE INVENTION

The number of people with sore throats in the United States that seekmedical attention is an estimated 120 million visits per year.Approximately 12 to 25 percent of those individuals have positive strepcultures. Far more individuals than those diagnosed with strep throatare placed on antibiotics because there are no other availabletreatments. Streptococcus is one of the most frequent causes for visitsto the doctor's office in the United States. It is also one of the mostfrequent reasons for antibiotic use. Streptococcus is also a concern dueto the development of not only throat infections, but also due to theother sequella of the infection, namely rheumatoid heart disease. Thisis where the organism invades the blood stream and causes vegetations onthe heart valves.

Streptococcus is a genus of spherical, Gram-positive bacteria that areknown to be the primary cause of throat infections in humans.Streptococcal sore throat, or strep throat as it is more commonlycalled, is an infection of the mucous membranes lining the pharynx.Sometimes the tonsils are also infected (tonsillitis). Streptococcuspyogenes, a group A Streptococcus (GAS), is the causative agent in GroupA for Streptococcal infections including strep throat, acute rheumaticfever, scarlet fever and acute glomerulonephritis (inflation of theglomeruli). The reason why S. pyogenes sometimes causes disease is notentirely understood, but both bacterial virulence factors and hostfactors are thought to contribute. The microbiota is one such hostfactor that needs further investigation. Attachment to epithelial cellsis the crucial initial step of colonization because non-adherent GAS isremoved by mucus and saliva flow.

Conventional therapy for S. pyogenes infections has mainly consisted oftreatment with antibiotics such as penicillin and tetracycline. Thelarge numbers of people that are prescribed antibiotics for this illnesshelps to increase the incidence of resistant bacteria as observed inrising levels of antibiotic resistant infections in the public.Antibiotics that were once almost universally effective against theseinfections are now approximately 70 to 80% effective. Moreover,antibiotics such as penicillin and tetracycline, exhibit broad spectrumantimicrobial activity. Thus, treatment with these antibiotics tends tokill not only S. pyogenes but a number of other bacterial species, someof which may actually be beneficial to the body. Although S. pyogenesmay be treated using antibiotics, a prophylactic vaccine to prevent theonset of disease has been desired. Efforts to develop such a vaccinehave been ongoing for many decades, but yet, to date, there are no GASvaccines available to the public.

There is a long felt but unsolved need for a preventative treatment forsore throat and especially one that does not present the problemsassociated with the use of antibiotics.

SUMMARY OF THE INVENTION

Various embodiments of the present invention are directed to a methodand system that a person can employ when they first fear they may becoming down with a sore throat or just prior to full blown feelings of asore throat. The application of a strip to the soft palate region oftheir throat is believed to eliminate the chances they will experienceand suffer a sore throat. This is because the strips as described hereinare effective in diminishing, if not precluding or prohibiting thegrowth of particular bacteria, especially S. pyogenes, which is largelyresponsible for sore throats. The provision on or in such strip ofcertain sugars, including xylitol but also certain otheroligosaccharides, in concert with other structural features of thesurface of such strip that make bacteria avoid such surface, becausethey cannot adhere well thereto, prevents the continued progression of asore throat that a person would otherwise experience. Moreover, incertain other embodiments, coaggregation of S. pyogenes is achieved bypopulating the strip with an effective amount of preferred lactic acidbacteria (LAB) that are able to coaggregate specifically withStreptococcus pyogenes. Coaggregation is understood in the sense of theinvention in particular as adhesion, interaction, binding, specificbinding, affinity or interaction and characterizes in particular theability of the preferred microorganisms to form agglomerates withStreptococcus pyogenes. S. pyogenes has evolved a number of differenttypes of molecules, referred to as “adherens,” on its surface which canvery tightly stick to one or more molecules that are part of the host'svarious surfaces. Few strains of Lactobacillus are capable of preventingthe binding of Streptococcus pyogenes (group A streptococci, alsoreferred to as GAS) GAS to human cell lines. The Lactobacillus strainscompete with GAS for surface structures on the cells and thus preventGAS from invading the host cells. Adhesion of Streptococcus pyogenes tothe host cell is the first step in pathogenesis, and the invasionprocess into the host cells takes place in very short order. The earlyuse of therapeutic agents for prevention and treatment are of crucialimportance to reduce the total GAS microbe count and to efficientlyprevent the binding, ie., invasion of Streptococcus pyogenes, is oneobjective of the present invention. Use of certain LAB in variousaspects of the present invention preferably involves the followingmicroorganisms deposited with the German Collection for Microorganismsand Cell Cultures under the code numbers DSM 25972, DSM 25987, DSM25988, DSM 25989, DSM 25973.

One objective is to decrease the colonization of the oropharynx, andtherefore decrease symptoms of the sore inflamed throat and ultimatelydecrease the need for antibiotics. In certain embodiments of the presentinvention, conjugated oligosaccharides are employed to specificallyinhibit the adherence of S. pyogenes to pharyngeal and oral mucosalcells. In the first stages of infection, bacterial adhesins, adhesivemolecules on the surface of bacteria, bind to receptor materials on thehost cell membrane. Thus, certain embodiments of the present inventionare directed to defeating the adherence of S. pyogenes to a person'soral tissue in a manner that results in avoiding a sore throat.

Pathogenic bacteria display various levels of host specificity ortropism. While many bacteria can infect a wide range of hosts, certainbacteria have strict host selectivity for humans as obligate humanpathogens. Host specificity of bacterial pathogens is determined bymultiple molecular interactions between the pathogens and their hosts. Anumber of bacteria are highly adapted to the human environment anddisplay strict host selectivity for humans, including Haemophilusinfluenzae, Helicobacter pylori, Neisseria gonorrhoeae, Neisseriameningitidis, Mycobacterium leprae, Salmonella Typhi, Streptococcuspneumoniae, Streptococcus pyogenes, Vibrio cholerae and Treponemapallidum. Hereinafter these bacteria will be referred to ashuman-specific pathogens. The cause of strep throat, Streptococcuspyogenes, exhibits tissue tropism, i.e. it is virtually found only inhumans. One aspect of the present invention, described in detail withrespect to sore throat infections but not to be intended to be solimited, is the modification of human specific pathogens to alter ordestroy their respective virulence factors, preferably by employingCRISPR-Cas systems, and in so doing, alleviating diseases caused by suchmicrobes without the threat of undesired consequences stemming from amore global and universial modification of bacteria serving otherbeneficial functions in our environment. In certain embodimentsCRISPR-Cas is employed to silence or to delete certain virulence factorsof microbes, specifically the virulence factors of S. pyogenes, andespecially adhesions involved in interspecies coaggregation.

To comply with appropriate written description and enablementrequirements and to provide sufficient guidance in how one of skill inthe art can make and use the various and numerous embodiments of thepresent invention, incorporated herein in their entireties are thefollowing, generally directed to S. pyogenes: U.S. Pat. No. 5,583,765 toStolle et. al.; U.S. Pat. No. 5,585,098 to Coleman; U.S. Pat. No.9,056,912 to Grandi; U.S. Pat. No. 9,131,884 to Holmes; US Pat.Publication No. 2014/0065218 to Lang et. al; PCT/US2007/023166 toMitteness; 2015/0224072 to Pellikaan; U.S. Pat. No. 9.095,704 toMcGuire; 2015/0290026 to Kovarik; U.S. Pat. No. 6,552,024 to Chen;2003/015656 to Jackson et. al.; and 2005/0260544 to Jones et. al.

Various embodiments of the present invention relate to an improvedmethod and system of inhibiting adherence, and thus promoting desorptionof S. pyogenes to soft tissue surfaces, such as the pharyngeal and oralmucosa of a human, by treating these areas with one or more of theembodiments described herein directed to a mucoadhesive strip.Particular embodiments are directed to oral strips having a surfacetopography that resists bioadhesion of undesired bacteria that aretypically present in a human's mouth. The strips preferably have asurface that is anti-microbial in nature, such that such strips assistin reducing the surface area in the mouth where noxious odors may arisedue to the proliferation of foul smelling agents produced by bacteriathat can survive in one's mouth.

Thus, one aspect of the present invention is directed to the novelcombination of a specifically surface structured bioadhesivelyattachable, and in a preferred embodiment, dissolvable, strip ofmaterial that persists in the mouth for at least one hour and preferablyat least about 3 hours, so as to reside on the tissue of the throatwhere S. pyogenes would otherwise reside, specifically the soft palateand thus reduce the occurrence of sore throat. The ability to defeat theproliferation of bacteria, including but not limited to S. pyogenes, ina person's mouth can significantly decrease the occurrence of so-called“morning breath”.

Certain embodiments entail the use of a specially textured surface,either one both or at least the outer side of an adhesive strip (theside facing away from the mucosal tissue to which it is attached) thathas anti-microbial characteristics. In one such embodiment, the surfacetopography is such that it resists bioadhesion of undesired bacteriathat are typically present in a human's mouth. Such a surface maycomprise a layer or coating that comprises a pattern defined by aplurality of spaced apart features attached to or projected into a basesurface, with a plurality of features each having at least onemicroscale dimension and having at least one neighboring feature havinga substantially different geometry, and having an average spacingbetween adjacent ones of said features of between 0.5 and 5 .mu.m.Incorporated herein by this reference is U.S. Pat. No. 7,650,848 toaddress written description and enablement issues regarding the use ofsuitable textures and surfaces that may be employed. Thus, preferredembodiments include strips that have a surface upon which bacteria donot like to grow, in particular, surfaces having a surface textureand/or pattern that faces away from the mucosal contacting side of thestrip and that reduces the number of bacteria that would normally occupysuch surface area of the mucosal membrane where the patch/strip noadhered thereto, creates a surface upon which bacteria do not like togrow. Exemplary surfaces that can be employed for such purpose includethose in FIG. 2(a-d).

Certain embodiments of the patch (or strip as alternatively referred toherein) have overall geometries particularly suited for the individual'smouth and are customizable therefore. As such, perforated tear linessuch that smaller sizes can be fashioned easily. Other geometries ofstrips are such that they limit common “gag reflexes” of a person.Particular strips are designed so as to also extend over not only amajority of the soft palate region, but also over the hard palate, so asto further reduce the incidence of gag reflexes being triggered. Certainembodiments have toxic substances associated with the surface of thestrips, thereby killing certain undesired bacteria in the mouth.

Certain other embodiments comprise bioluminescent strips to facilitate auser's ability to view (in a mirror) the correct placement of the stripsin one's throat. Bioluminescence is a type of chemiluminescence and incertain embodiments, a catalytic protein increases the efficiency ofchemiluminescent reaction such that a bioluminescent protein isdetermined by detecting the presence of luminescence. Bioluminescentcompounds that may be employed in the present invention embodimentsinclude luciferin, luciferase and aequorin. Other embodiments employdifferences in visual appearance to determine whether a patch is placedproperly; whether certain desired or undesired bacteria are present inthe mouth, etc, and such effective means for determining the sameinclude a film, coating or patch that includes one or more of thefollowing characteristics: reflectance, retroreflectance, fluorescence,photoluminescent light transmission, color, tinting strength, andwhiteness. Certain embodiments also assist in the detection of whether aperson has a certain medical condition, such as strep throat. Thus, inone embodiment, the patch changes color, expresses bioluminescence, etc.if there is strep bacteria present in a predetermined amount.Incorporated herein by this reference for written description purposesin this regard is U.S. Pat. Publication No. 20110250626 to Williams, etal.

Certain other embodiments include strips with compounds residing thereonto facilitate the growth of desired bacteria, such as those deemedbeneficial or at least not detrimental to a person's health.

Another aspect of the present invention includes the ability to load orimpregnate the mucosal strips with any number of active agents toachieve other desirable aspects, such as breath freshening;administration of particular vitamins, medicinal components, salving ofmouth sores, short or long term medication through buccal and mucosaltissues, but especially certain modified bacteria, such as S. pyogenes,or LAB as described herein, to lessen the chances of a sore throatinfection.

The particular dimensions, thickness, size, area surface texture,flexibility, adhesive characteristics, flavoring and taste, composition(e.g. in terms of medicine, vitamins, nutraceuticals, etc.) for aparticular strip can be adjusted as one of skill in the art willappreciate. In one embodiment, and unlike most presently availablebreath strips (e.g. such as Listerine breath strips) the strips employedin the present invention are both thicker, so as to provide morestructural integrity to soft palate tissues upon which such stripsadhere, and also have more long term (from at least about 5 minutes toseveral hours), preferably for at least about 3 hours, more preferablyat least about 5 hours and most preferably at least about 6 or morehours—roughly equating to the period of time of a person's sleep

Moreover, in preferred embodiments the mucosal strips are designed toadhere well with each other when placed on palate tissue so thatlayering of the strips can be accomplished so as to custom build adesired thickness of the strips over tissue to be covered.

The area of tissue to be covered can be addressed by either having theperson provide strips side-by-side to cover the area; by having certaintissue areas provided with thicker ultimate strip depth than other areas(e.g. providing for the option of stiffening certain palate soft tissuemore than directly adjacent tissue), and even providing strips havingdifferent characteristics in terms of a variety of factors, such astaste, composition, adherence or dissolvability characteristics, area,shape, thickness, flavor, duration of flexibility characteristics, etc.In some embodiments, films of desired thickness and having desiredproperties in terms of dissolving rate, flexibility, provision ofstiffness over time, adhesion duration, ability to cause reversiblecontraction of soft palate tissue.

While in some embodiments standard sized strips of material may beavailable such that a person can layer, place side-by-side, orientdistinctly, etc. strips of appropriately selected strips, on otherembodiments, custom strips or films having particular shapes, such asone that covers the particular area of that particular person's softpalate tissue region, is contemplated. As disclosed herein below, stripsare referred alternatively to oral films, mucosal films, etc.

Oral films having desired duration of adhesion and freedom from anadverse feeling in the oral cavity on use are selected that adhere tothe particular regions of a person's soft palate.

Reference herein to a strip is to any soluble prolonged releasepresentation of the composition which is conformable and is adapted tolie in a subject's mouth without causing obstruction or interfering withbreathing, talking or swallowing or the like, or to conform to thesurface of a subjects open skin or wound. Preferably the strip comprisesa flexible film or the like. In use, the strip to be placed in asubject's mouth is intended to be placed at the back of the throat.Preferably the strip (or strips, whether layered, certain portions moredissolvable than others, etc.) are positioned on a person's soft palate.This can be achieved via a person's fingers or through the use of anapplicator (otherwise described and illustrated.) The strip isparticularly suited to delivery of ingredients by delivery to the mucosaof the throat, in particular at the soft tissue in the pharyngeal regionof the back of the throat, to keep the pharyngeal membranes moist andlubricated.

The strip is conformed as a relatively thin planar structure tofacilitate desired rates of inter-oral dissolution. For example, incertain embodiments, a single strip may be preferably no more than about150 micron thick, more preferably in the range 100-400 micron thick, andin other embodiments may be over 500 microns in thickness. In otherembodiments, however, the ability to layer strips on top of one anotherprovides for the manufacture and availability of strips of moretraditional thickness, such as those for example of the breath strips ofListerine, etc. The strip may be of any suitable shape, for examplebeing square or rectangular for ease of storage, placement, distributionin packages, but is preferably generally planar and approximately 0.5 to2 cm in length and breadth.

In certain embodiments, the strip is manufactured from a material whichis soluble within the subject's mouth under the action of saliva andoral enzymes, or under the action of tissue fluids. In otherembodiments, however, the strip is made so as not to dissolve and thus,is repeatedly applied to a person's soft palate.

A reusable device that adds the requisite structure to the particularsoft palate tissue can have appropriate adhesive integral or added asneeded to remain in a desired position. The customization of such astrip in terms of shape, size, characteristics regarding flavor,thickness, adhesive qualities etc. are within the present scope of theinvention.

In certain embodiments, the base material for the strip is any suitablesoluble solid material, which term includes gel-like and other materialswhich are sufficiently solid to enable the strip to be conformed to itsdesired shape. In particular, a carrier or base material of the stripmay comprise a soluble gel material, and is for example based upon on anorganic gel, which could for example be a fish, animal, bovine or marinegelatin or vegetal gelatin-like product, a polysaccharide, a cellulosicmaterial, pectin such as from fruits, or other suitable base. Othermaterials may be added to the base gel, for example to stabilize, addother effects flavor etc. The carrier or soluble base material may beinert, or may itself have an activity or other desired property, whetherin relation to the primary purpose of the invention or otherwise.

Active agents may be used either impregnated in the strip material,added later, layered in a fashion so that an adhesive strip is separatefrom an active layer strip; the provision of strips that can encompassor otherwise carry one or more active ingredient strips, liquids, etc.in a pouch or encapsulation such that administration of various activeingredients can be achieved via attachment of an active ingredientcontainer to the soft palate adhesive strip. Time release and slowrelease aspects of delivery can be achieved via suitable selection ofpermeable barriers employed to contain active ingredients and then theassociation of such barriers to soft palate adhesive strips. Thelayering of strip for separate and distinct purposes of structuraltissue support versus for administering active ingredients is a entiresegment of different embodiments of the present invention.

Components that can be included in strips or associated with strips inthe various ways described herein include agents that may includeadditional active ingredients, including a plurality of activeingredients having an activity in relation to a particular condition orthe throat or throat disorder, oral conditions, open skin or woundhealing or repair agents and/or active ingredients having other desiredactivity.

Preferably in certain embodiments, active ingredients include at leastone active ingredient with physical (moisturizing, lubricating, coolingetc) or pharmacological (for example decongestant, anti-histamine,anti-bacterial, anti-inflammatory, analgesic etc) activity. For example,active ingredients might include ingredients having any desired physicalor pharmacological activity on the mucous membranes of the throat,including without limitation decongestants, lubricants, antibacterialand antiseptic compositions, anti-histamines, anti-inflammatorycompositions, analgesics, and other medicaments and non-medicaments.Additional ingredients may include breath-fresheners and deodorizers.Inactive ingredients may be added in suspension or solution for exampleto stabilize or preserve the soluble base, balance the pH of the base,bring the base to closer approximation to isotonic concentration etc.The composition may additionally include adjuvants and the like such asvitamins for example selected from Ascorbic acid (vitamin C) whichenhance the active ingredient effect. The composition may includeadditional ingredients for formulation purposes, for example selectedfrom sodium chloride which maintains favorable isotonicity.

In still other embodiments, the use of additional ingredients mayprovide for chemical binding, and for example for the use of liposometechnology, can be employed. In some embodiments of the invention a partor all of the active ingredients are encapsulated within encapsulationstructures selected to provide the desired degree of adhesion to themucous membranes of the throat, and adapted to release the activeingredients slowly over time in situ. These encapsulation structures maybe distributed within the base material in the strip composition. In oneembodiment, the encapsulation structures comprise multilamellarmicroparticles. The multilamellar microparticles are selected to exhibitgood adhesion to the mucous membranes of the throat, and are smallenough to be effectively distributed in the strip. The multiple layersmay be structured to give slow release of the active ingredient over thedesired time period, so that a single strip dose gives sustainedactivity over time, for example providing for measurable activity for asustained period of four or more hours, and ideally of for example 6 to12 hours, to give overnight effectiveness.

Microparticles are preferably sized and shaped to form an effectivedistribution within the base material in the strip as a composition inaccordance with the invention. The microparticles in particular comprisegenerally spherical particles or microspheres. Particle sizes in therange 0.1 to 50 .mu.m, and for example 1 to 20 .mu.m are likely to bepreferred. Particle levels of 5-25% within the composition are preferredbut depend on the particular tissue characteristics being addressed.

Microparticles may be are adapted to facilitate slow release of theactive ingredients over time, and are preferably inherently able to showgood adhesion to the mucous membranes of the throat. Active ingredientsare thus stabilized in situ on the mucous membranes at the back of thethroat, and then released steadily at the site where they are required.

Using the present invention, it becomes possible to maintain reasonablelevels of activity over the sort of time scale necessary to be effectiveovernight, and for example to assist in providing a relatively lessdisturbed night's sleep. Microparticles comprise multiple layeredstructures formulated with one or more of: surfactant layers (comprisingany type of surfactant such as anionic, non-anionic, cationic,phospholipids and the like such as sucroesters and guarhydroxypropyltrimonium chloride), and hydrophobic or lipophilicmaterials such as aliphatic and aromatic hydrocarbons, optionallyhalogenated, higher alcohols, ketones and the like, for exampleincluding Vitamins (A, E, D), carotenoides, polyphenols, vegetable oils,essential oils, phytosterols, lipophilic preservatives, menthol,linalool, eucalyptol, and the like; and polar layers including solventsor polar media such as water, glycerol, PEG, sorbitol, glycol,hydrophilic materials such as alcohols or ethoxylated alcohols,carboxylic acids or salt of a fatty acid, quaternary ammoniumderivatives, sulphonates or sulphates and the like, vitamins (B, C),flavonoides, 18-beta glycyrrhetinic acid and derivatives, glycerol,active ingredients such as plant extract as hereinbefore defined;hydrophilic preservative; cellulose polymer, hyaluronic acid andderivatives, alpha-hydroxide acid, and the like. Also possible inclusionare pectin; cellulose; sodium hyaluronate; guar hydroxypropyltrimoniumchloride; polysorbate 60, and optionally additionally cellulose; xanthangum; chitosan or quaternary ammonium. In one embodiment, such stripcomposition comprises: solvent 30-60%, Humectant 8-14%, Texturant 0-2%,Preservative 0-2%, and an Acidity regulator 0-1% (all by weight).Microparticles thus preferably comprise multi-lamellar structures ofsurfactant layers, which are able to encapsulate active ingredients to avery high degree for protection and controlled release—whether that berapid release (e.g. for certain tissue stiffening components) or longerterm release, such as breath freshing components). The strips areformulated to be adapted to enhance adhesion to human skin, and hence tofix the particles in position on the mucous membranes of the throat.Suitable compositions include 30 to 50% surfactant, 30 to 50% polarmedium, and 10 to 60% active binding agent, comprising hydrophilic andhydrophobic agents as appropriate.

Microparticles are advantageous to fix the active ingredients adsorbedwithin each shaped layer in position on the mucous membranes of theuser, protect the active ingredients and slowly release them in situ,and might also assist in providing a desired lubricating effect. Activeor inactive ingredients might be provided either encapsulated within themicroparticles or separately in suspension or solution within the basefor various purposes.

Formulation of oral drug strips involves the application of bothaesthetic and performance characteristics such as strip-formingpolymers, plasticizers, active pharmaceutical ingredient, sweeteningagents, saliva stimulating agent, flavoring agents, coloring agents,stabilizing and thickening agents. From the regulatory perspectives, allexcipients used in the formulation of oral drug strips should beapproved for use in oral pharmaceutical dosage forms. For example, filmsthat incorporate a pharmaceutically active ingredient are disclosed inexpired U.S. Pat. No. 4,136,145 to Fuchs, et al. These films may beformed into a sheet, dried and then cut into individual doses.

With respect to manufacturing of strips, one of skill in the art willappreciate the various methods and components involved to achievedesired qualitative and quantitative aspects. For example, if adissolvable strip is intended to last over a several hour period, thechanges in content of materials used in the manufacture, for example, ofbreath strips, can be adjusted to lengthen the time it takes to dissolvesuch strip. Flavor, binding and adhesion abilities, etc. are adjustedsuitably to achieve desired results. Thus, while the presentspecification provides some detail as to how to make and use certainembodiments of the present invention, reliance on incorporation byreference is appropriate to encompass the myriad of ways in which aparticular product is produced. All of such techniques, however, arewell within the skill of one of ordinary skill in the art in view of theguidance and direction provided herein.

Preferably the strips of the present invention are made in a manner thatdo not dissolve in fewer than ten seconds, thus distinguishing the samefrom common breath strips widely available. The strips of the presentinvention may have a weight of from 30 to several hundred mg.,preferably over 33 mg. Preferably, strips of the present invention havesufficiently high moisture content to impart the product withflexibility and to avoid becoming brittle, e.g. the strips shouldpreferably avoid cracking when bent.

In certain embodiments, the methods employed by MonoSol Rx with respectto a thin film drug delivery technology can be used, preferablyproviding a strip having a relatively thin film, which is similar insize, shape and thickness to a postage stamp. Preferably, the strips ofthe present invention, when containing active ingredients, have theability to carry doses of prescription products up to 80 mg or exceeding1000 mg, and even more preferably, over 200 mg. Suitable taste maskingagents can be employed depending upon the active ingredients involved.

Other embodiments of the present invention are directed to multiple filmlaminates that can have distinct adherence and qualitative features andcomponents associated with separate layers, thus facilitatingdifferences in manufacture, activity, structural characteristics, suchas flexibility, dissolution rate, etc. The strips of the presentinvention provide the requisite pliability and tensile strengthnecessary to securely adhere to a person's mucosal tissues for at leastone hour, more preferably at least two hours, and even preferably abioadhesive polymer is selected from the group consisting ofpolycarbophil, carbomer, one or more acrylic polymers, one or morepolyacrylic acids, copolymers of these polymers, a water soluble salt ofa co-polymer of methyl vinyl ether and maleic acid or anhydride, acombination thereof and their salts.

In other embodiments, to achieve the desired thickness of strips forstructural support purposes of the present invention, a so-called slabor sheet manufacturing technique is employed that uses a nonaqueous,extrudable composition comprising at least one thermoplastic polymer inan amount of more than 20 wt % of the whole composition, suchcomposition comprising at least one thermoplastic polymer and one ormore bioactive ingredients in a form that may be placed on the mucosaand having an average dissolution time of preferably more than 50minutes, more preferably at least about 2 hours, and even morepreferably at least about 5 hours. In some embodiments the strip is in asheet and has a surface area of approximately 0.25-1.5 in. and athickness of approximately 10-70 mil. A strip may be impregnated orcoated with a dose of active ingredient and other components.Preferably, strips of the present invention comprise a mixture of atleast three types of film forming agents, such as maltodextrins, fillers(for example, microcrystalline cellulose (MCC)) and hydrocolloids (forexample, sodium aliginate), suitably adapted to adhere to oral surfacesof an oral cavity, and in particular the soft palate. While structuralsupport for the soft palate is the principal direction of the presentinvention, embodiments also comprise the use of such strips to deliveror release oral care agent(s). Such agents include anti-microbial agentsand salivary stimulants to treat, for example, halitosis, dental plaque,gingivitis, xerostomia, dry mouth, like oral conditions or combinationsthereof. Further, the oral care edible film can act as a breathfreshener effective against malodor. In other embodiments, both a longeracting (if not entirely non-dissolvable strip) can be employed inassociation with one or more other strips having other desiredcharacteristics. For example, a structural support strip can be used toachieve breath freshening, delivery of a medicinal compound, etc.—withsuch second strip having entirely distinct dissolution characteristics.

The oral cleansing and breath freshening effects of the edible film ofthe present invention can be achieved by entrapping the oral care agentswithin the oral cavity to provide extended efficacy. In this regard, thehighly dissolvable edible film can act as a medium through which apharmaceutically active oral agent can be administered via a mucousmembrane of the oral cavity.

Strips may further include a variety of other suitable ingredients, suchas softeners, colorants, flavoring agents, emulsifiers, surface activeagents, thickening agents, binding agents, sweeteners, fragrances, otherlike ingredients or combinations thereof.

The strips may comprise a hydrocolloid of any suitable type, amount andnumber of hydrocolloids. In an embodiment, the hydrocolloid canconstitute between about 10% to about 50% by dry weight of the ediblefilm, preferably about 20% to about 30% by dry weight. The hydrocolloidcan be derived from, for example, natural seaweeds, natural seed gum,natural plant exudates, natural fiber extracts, biosynthetic gums,gelatins, biosynthetic process starch or cellulosic materials,alginates, sodium alginate, calcium alginate, carrageenans, guar gum,locust gum, tara gum, gum arabic, ghatti gum, agar gum, xanthan gum,pectin, other like hydrocolloid source material or combinations thereof.

In certain embodiments of the present invention, the size and number ofadhesive strips contacting the soft palate of a person can be varied.For example, while a larger size strip (e.g. an expanse of material thatcovers a particular area of soft palate tissue) can be greater than thedimensional area of a person's soft palate, thereby extending beyond theperimeter of the soft palate, it can also be of a smaller area and mayextend therefore over only some, e.g. a central portion; half of thearea of the soft palate—leaving the other side of the soft palate areauncovered by any strip, etc. Moreover, more than one strip can beemployed to attach to the soft palate region, such as by providing twoseparate smaller strips on the soft palate with some space between, morepreferably at least three or more individual strips within the softpalate region.

Incorporated herein by this reference is 2011/0009834 to Asmussen withrespect to various particular components that can be utilized to formstrips. The strip-shaped forms can comprise a flexible material suitablefor pharmaceutical and/or cosmetic use by humans and/or in animals, i.e.materials that do not have any unwanted side effects. Unwanted sideeffects would be toxic effects, the causing of irritations or thetriggering of allergic reactions, for example. Suitable materials maybe, for example, thermoplastic polymers, thermoset polymers, copolymerfilms, paper, waxes, textiles (nonwovens, knitted fabrics and wovenfabrics), chalks, films, gels and wood composites, as well ascombinations of the aforementioned materials. Specific polymers suitableas material for the strips may be selected from the group of polymersconsisting of cellulose ethers, methyl acrylates, hydroxyalkylcelluloses such as hydroxypropyl methyl cellulose, hydroxypropylcellulose, hydroxyethyl cellulose, methyl cellulose and carboxymethylcellulose, polysulfones, polyvinyl pyrrolidones, crosslinked polyvinylpyrrolidones, polyvinyl pyrrolidone-vinyl acetate copolymers, polyvinylalcohols, polyacrylic acids, polyacrylate polymers, crosslinkedpolyacrylic acids, polyethylene oxides, polyethylene glycols, polyvinylalkyl ether-maleic acid imide copolymers and carboxyvinyl polymers.Suitable polymers may also be selected from the group of polymersconsisting of marine colloids, natural gums and polysaccharides. Thesepolymers include, for example, sodium alginate, carrageenan, xanthangum, gum acacia, gum arabic, guar gum, pullulan, agar, chitin, chitosan,pectin, karaya gum, zein, hordein, gliadin, carob meal, tragacanth andother polysaccharides, starches such as maltodextrins, amylose,amylopectin, maize starch, potato starch, rice starch, tapioca starch,pea starch, sweet potato starch, barley starch, wheat starch, waxy maizestarch, modified starch, dextrins, levan, elsinan and gluten; andproteins such as collagen, whey protein, casein, milk protein, soyaprotein, gelatine, waxes and colophony, as well as synthetic waxes andbees wax. By combining two or more of the aforementioned polymers, theproperties of the strip of material, such as mucoadhesiveness,flexibility, solubility behaviour, swelling behaviour and the like, canbe adapted according to one's wishes and requirements. The strip ofmaterial, or the layers of the strip of material, comprise/comprises atleast one polymer, which represents an essential component of the stripof material or of the layer(s). The polymer portion amounts to at least5%-wt. and preferably not more than 90%-wt., preferably 10 to 70%-wt.,more preferably 30 to 60%-wt., in each case relative to the strip ofmaterial or the layer, respectively. The strip of material, orindividual layers of the strip of material, can furthermore containexcipients or additives in order to control the chemical or physicalproperties, such as flexibility, mucoadhesive properties,disintegratability, swellability and/or diffusion properties. To betaken into consideration as excipients or additives are, in particular,substances selected from the group consisting of antioxidants,emulsifiers, gelling agents, flavour enhancers, taste corrigents,flavours, sweeteners, stabilisers, pH regulators, acidifying agents,bulking agents, preservatives, colourings, thickening agents,plasticisers and humectants. Those skilled in the art will know suitableexcipients and additives approved for pharmaceutical applications.

In one embodiment, the strip has a surface adapted to promote tissuein-growth, and in other embodiments, the growth of desired bacteria,especially those bacteria modified as described herein, such as via aCRISPR-Cas system. The in-growth promoting surface is desirably selectedfrom a group of outer surfaces including a textured surface, a poroussurface, a braided surface, a mesh surface, a fleece surface, and acoating for inducing bone or tissue in-growth.

Various embodiments are directed to a buccal bioadhesive strip, thatwhen applied to the soft palate, has a surface that is anti-microbial innature, preferably one that S. pyogenes cannot readily adhere to, suchthat such strips assist in reducing the surface area in the mouth whereS. pyogenes can exist and grow. Such strips also have the attribute ofpreventing noxious odors that may arise due to the proliferation of foulsmelling agents produced by bacteria that can survive in one's mouth.

Other embodiments are directed to a buccal bioadhesive strip adapted tobe attached to the tissue of the soft palate, such strip including atleast one surface that has a pattern defined by a plurality of spacedapart features each having at least one microscale dimension and havingat least one neighboring feature having a substantially differentgeometry, wherein an average spacing between adjacent ones of saidfeatures is between 0.5 and 5 .mu.m.

Preferably, the strip has a first and second side, the first side havinga bioadhesive that is adapted to bind to a mucosal membrane for at least1 hour while inside a person's mouth, wherein the strip extends over amajority of the soft palate. In certain embodiments, the strip includesxylitol and at least one encapsulated pocket containing one of ananalgesic, a solution containing a LAB, selected from the groupconsisting of a LAB that coaggregate with S. pyogenes. Preferably thestrip reduces the adhesion of S. pyogenes to the epithelial tissue of aperson's mouth and also includes between 0.2 and 0.9% xylitol by weight.Certain strips are made with bioluminescent material and/or materialthat reacts specifically with ultraviolet light to kill bacteria on thestrip. Projection of UV light onto the strip to destroy bacteria after acertain amount of time is one aspect of the present invention. While thestrip may be non-dissolvable in a person's mouth, preferably it isdissolvable in a person's mouth within a period of 3 hours.

In certain embodiments, a mucosal adhesive strip has a coated surfacefor resisting bioadhesion that includes at least one patterned polymerincluding coating layer having a plurality of features attached to orprojected into a base surface. The features each have at least onemicroscale (<1 mm) dimension and have at least one neighboring featurehaving a substantially different geometry. The patterned coating layerpreferably provides an average roughness factor (R) of from 4 to 50. Thecoating layer resists or enhances bioadhesion as compared to the basesurface. An article having a surface coating with topography forcontrolling bioadhesion comprises a base surface, at least one patternedpolymer comprising coating layer including a plurality of spaced apartfeatures attached to or projected into the base surface which provide atleast a first feature spacing distance. The features each have at leastone microscale dimension and at least one neighboring feature having asubstantially different geometry. The coating layer provides an averageroughness factor (R) of from 2 to 50, preferably being from 4 to 50. Thecoating layer resists or enhances bioadhesion as compared to the basesurface.

Still other embodiments include the use of bacteria that have beenmodified to remove or disable one or more virulence factors of theparticular bacteria. Key virulence factors present in GAS includestreptococcal pyrogenic exotoxin (SPE)-B, the hyaluronan synthesisoperon and active superantigen against human immune cells. A key eventin the ability of GAS to cause severe invasive streptococcal infectionis the acquisition of novel genetic traits. During severe invasiveinfection, however, GAS destroys its own covRS (for “control ofvirulence genes”) two-component system, which negatively regulates manyvirulence factor genes, resulting in a hyper-virulent phenotype.Modification of GAS, preferably using CRISPR-Cas and Cpl1, can addresssuch virulent strains and thus control the infections.

These modified bacteria, especially those that demonstrate humanspecificity, are used to competitively inhibit or to otherwise populatetissue surfaces, such as the oral cavity, to prevent a variety ofdiseases. In this regard, one aspect of the present invention isdirected to the modification of certain human-specific pathogens bytargeting one or more virulence factors thereof, preferably by usingCRISPR-Cas or CRISPR-Cpl1 systems, to excise virulence factors genes, orat least portions thereof or transcriptional or translational controlstherefore, such that such pathogenic pathogens are deprived of theirundesired pathogenic characteristics. One of skill in the art canreadily assess the number and identity of human-specific pathogens, aswell as the particular virulence factors associated therewith, and canthen, employing the CRISPR systems as referenced herein, remove, renderincapable or otherwise disable the virulence facts of suchmicroorganisms such that they no long pose a pathogenic threat tohumans. In various aspects of the present invention, there is apurposeful exposure of individuals to such modified pathogens such thatthe population of the same, for example in the oral cavity or the humangut, competitively inhibits the infection of non-modified pathogenicmicrobes of the same species. In one particular embodiment, S. pyogenesis modified to render ineffective one or more virulence facts such thatthe progression of a sore throat is avoided.

The concerns relating to possible unintended consequences from thegenetic modification of genomes, especially the human genome, arelargely if not entirely addressed in various embodiments of the presentinvention as modifications are not being made to the human genome—butrather to microbes. Moreover, in preferred embodiments, the microbesmodified are limited to those demonstrating human tropism such thatundesired and unintended changes to other animals and organisms are notaffected and that the only implications of such genomic alterations ofhuman specific pathogens are restricted to such species in a manner thatis not capable of affecting other than the particular human disease atissue. This can include, for example, modifications and/or employment ofintegrons, which are a two-component genetic recombination systempresent in the chromosome of many bacterial species. The integronincorporates mobile genes termed gene cassettes into a reserved geneticsite via site-specific recombination, named the Integron/gene cassettesystem. The integron consists of three basic elements: an integrasegene, an attachment site and a promoter. These elements can bemanipulated to, for example, decrease the ability of a dominant S.pyogenes population in one's mouth from being able to effectively attachto epithelial tissue; or alternatively, to coaggregate with otherbacteria so as to be swalled and removed from the oral cavity, etc.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a cross-sectional view of a person's airway where a particularplacement of a strip is shown associated with the soft palate.

FIG. 2(a)-(d) illustrate some exemplary surface architectural patternsaccording to the invention.

FIG. 3 is a front perspective view of a person's open mouth,illustrating the placement of a strip on the surface of the soft palate.

FIG. 4A is an illustration of a person's mouth with a heart-shaped stripassociated with the soft palate.

FIG. 4B is an illustration of a person's mouth with a rectangular shapedstrip adhered to the soft palate with mucosal adhesive agents.

FIG. 5 is an illustration of a person's open mouth with a strip place onthe soft palate.

FIG. 6A is an illustration of a person's open mouth where a firstrectangular strip is over-laid by a 2nd circular strip.

FIG. 6B illustrates a strip having structural support elementsassociated therewith.

FIG. 7 illustrates a sore throat strip having cross-hatched supportstructure integral with the strip, said cross-hatched support structurealso including encapsulated agents, such as an antibiotic; lactic acidbacteria; S. pyogenes modified by a CRISPR-Cas system to reduce one ormore virulence factors; and a breath mint solution.

FIG. 8 is a cross-sectional view of a person's head where a sore throatstrip is anchored by a tongue loop anchor.

FIG. 9 illustrates a strip applicator for placing a sore throat stripproperly on the roof of an individual's mouth.

FIG. 10 is an illustration of a pre-made sheet of sore throat stripsthat can be disassociated with the sheet and then applied to mucosalmembranes.

FIG. 11 is a side view of one embodiment of a sore throat strip havingan outer layer, an adhesive layer, a layer with an encapsulated agentcontained there between.

FIG. 12 is a side view of one embodiment where the encapsulated agent isencapsulated into small beads that are frangible via pressure of anindividual's tongue pressing against the strip so as to force it intothe roof of a person's mouth.

DETAILED DESCRIPTION OF CERTAIN PREFERRED EMBODIMENTS

In various embodiments, the present invention includes a solublecomposition for the administration of an active ingredient to a site onthe mucus membranes of the throat of a human. A sore throat is initiallymostly viral in nature and common viruses may provide an initialconditioning to the host mucosa that favors bacterial adherence whichsubsequently leads to bacterial biofilm formation. To overcome theadhesion of the pathogens to the host mucosa is a viable strategy inpreventing infection. Additionally, the use of effective inhibitoryagents may also exert a therapeutic advantage by inhibiting extendedcolonization and restricting the spread of infection. Employment of thestrips as described herein can alleviate the onset and the progressionof sore throat via the various structures and functions as set forthherein.

The sore throat strips 10 are applied in a temporary rather thanpermanent manner. No prior art method or device employed in the battleagainst sore throats offers such a variety and flexibility of treatmentoptions as do the various embodiments of the present invention.

FIG. 1 shows, in cross-section, a naso-pharyngeal area of an untreatedpatient. FIG. 1 shows the nose N, mouth M and throat TH. The tongue T isshown in an oral cavity OC of the mouth. A hard palate HP (containing abone B) separates the oral cavity OC from the nasal cavity NC. The nasalconcha C (soft tissue which defines, in part, the nasal sinus—not shown)resides in the nasal cavity NC.

The soft palate SP (a muscle activated soft tissue not supported bybone) depends in cantilevered manner at a leading end LE from the hardpalate HP and terminates at a trailing end TE. Below the soft palate SP,the pharyngeal wall PW defines the throat passage TP. A nasal passage NPconnects the nasal cavity NC to the pharyngeal wall PW. Below anepiglottis EP, the throat passage TP divides into a trachea TR forpassing air to the lungs and an esophagus ES for passing food and drinkto the stomach.

The soft palate SP is operated by muscles (not separately shown andlabeled) to lift the soft palate SP to urge the trailing edge TE againstthe rear area of the pharyngeal wall PW. This seals the nasal cavity NCfrom the oral cavity OC during swallowing. The epiglottis EP closes thetrachea TR during swallowing and drinking and opens for breathing.

For purposes of this disclosure, the nasal cavity NC, oral cavity OC andthroat passage TP are collectively referred to as the naso-pharyngealarea of the patient with the area including the various body surfaceswhich cooperate to define the nasal cavity NC, oral cavity OC and throatpassage TP. These body surfaces include outer surfaces of the nasalconcha C, the upper and lower surfaces of the soft palate SP and outersurfaces of the pharyngeal wall PW. Outer surfaces mean surfaces exposedto air. Both the upper and lower surfaces of the soft palate SP areouter surfaces.

FIGS. 2(a)-(d) illustrate some exemplary architectural patterns that canbe used with the invention. FIG. 2(a) shows a riblet pattern havingfeatures spaced about 2 μm apart; FIG. 2(b) shows a star/clover pattern,FIG. 2(c) a gradient pattern, while FIG. 2(d) shows a triangle/circlepattern.

FIG. 3 is a front perspective view of a person's open mouth,illustrating the placement of a sore throat strip 10 on the surface ofthe soft palate 12 and the hard palate/soft palate junction 14. The areaof tissue to be covered can be addressed by either having the personprovide strips 10 side-by-side to cover the area; by having certaintissue areas provided with thicker ultimate strip depth than other areas(e.g. providing for the option of stiffening certain palate soft tissue12 more than directly adjacent tissue), and even providing strips 10having different characteristics in terms of a variety of factors, suchas taste, composition, adherence or dissolvability characteristics,area, shape, thickness, flavor, duration of flexibility characteristics,etc. Films may be selected of desired thickness and having desiredproperties in terms of dissolving rate, flexibility, provision ofstiffness over time, adhesion duration, ability to cause reversiblecontraction of soft palate 12 tissue and can be fashioned, by cutting,forming in a particular mold, etc. to cover a desired soft palate 12area. Custom strips 10 or films having particular shapes, such as onethat covers the particular area of that particular person's soft palate12 tissue region, is contemplated.

FIG. 4A is an illustration of a person's mouth and tongue 18 with aheart-shaped sore throat strip 10A associated with the soft palate 12and a teeth anchor 16 associated with such sore throat strip 10A.

FIG. 4B is an illustration of a person's mouth and tongue 18 with arectangular shaped sore throat strip 10 adhered to the soft palate 12with mucosal adhesive agents. The strip 10 may be of any suitable shape,for example being square or rectangular for ease of storage, placement,distribution in packages, but is preferably generally planar andapproximately 0.5 to 2 cm in length and breadth. Again, the particularshape and dimensions of a strip 10 can be varied as required to addressindividual issues, the degree of tissue stiffness of the soft palate 12required to address a particular issue, etc. Thus, one aspect of thepresent invention is that a person may modify the number, placement,kind, type, shape, time of application, frequency of application, etc.to address particular situations, which may vary over time and under anygiven set of circumstances. The customization of such a strip 10 interms of shape, size, characteristics regarding flavor, thickness,adhesive qualities etc. are within the present scope of the invention.

FIG. 5 is an illustration of a person's open mouth and tongue with asore throat strip 10 placed on the soft palate 12 and a dental flossattachment anchor 16 associated between the strip 10 and a the teeth. Toavoid fears that adhesion will not suffice to attach a strip 10 to aperson's soft palate 12 tissue, strips 10 can also be afforded anattachment line, such as dental floss, so that the strip can be alsoanchored to one's teeth, tooth or around the tongue 18 to ensure thatthe strip 10 does not present a choking hazard if detached. Thus, in oneembodiment, a loop or segment of dental floss anchored to teeth oraround gum line or a tongue 18 can prevent swallowing of the strip 10 ifit becomes detached. FIG. 5 further shows the hard palate/soft palatejunction 14.

FIG. 6A is an illustration of a person's open mouth and tongue 18 wherea first rectangular sore throat strip 10 is over-laid by a 2nd circularsore throat strip 10B. In one embodiment, the strips 10 employed providemore structural integrity to soft palate 12 tissues upon which suchstrips 10 adhere, and also have long term function (from at least about5 minutes to several hours), preferably for at least about 3 hours, morepreferably at least about 5 hours and most preferably at least about 6or more hours—roughly equating to the period of time of a person'ssleep. The mucosal strips 10 are designed to adhere well with each otherwhen placed on palate tissue 12 so that layering of the strips 10 can beaccomplished so as to custom build a desired thickness of the strips 10over tissue to be covered. This permits a user to layer as many strips10 as deemed necessary to stiffen the soft palate 12 tissue in a mannerthat is personally comfortable for such user while also being sufficientto address the particular issue experienced by such user.

FIG. 6B illustrates a sore throat strip 10 positioned above a person'stongue 18 having structural support elements 10C associated therewith.The sore throat strip 10 of the present invention may further includeone or more compositions, or alternatively, may solely be provided withmaterials meant and intended solely to provide desired structuralsupport to reduce vibrational movement of soft palate 12 tissues. Activeagents may be used either impregnated in the strip 10 material, addedlater (e.g. agents can be sprayed on such strips 10), layered in afashion so that an adhesive strip 10 is separate from an active layerstrip 10; the provision of strips 10 that can encompass or otherwisecarry one or more active ingredient strips 10, liquids, etc. in a pouch(not shown) such that administration of various active ingredients canbe achieved via attachment of an active ingredient container to the softpalate 12 adhesive strip 10. Time release and slow release aspects ofdelivery can be achieved via suitable selection of permeable barriersemployed to contain active ingredients and then the association of suchbarriers to soft palate 12 adhesive strips 10.

FIG. 7 illustrates a sore throat strip 10 having a cross-hatched supportstructure 10D integral with the strip 10 to provide desired damping ofvibrational movement of the soft palate 12. In one embodiment, thestrips 10 can comprise collagen or other tissue growth enhancingmaterial to further the stiffening of the soft palate 12 so as to reducethe occurrence of vibration when a person is sleeping. In still otherembodiments, the strips 10 are positioned to overlap with the hardpalate junction 14 as well as the soft palate 12.

FIG. 8 is a cross-sectional view of a person's head where a sore throatstrip 10 is anchored by a tongue loop anchor 22. The general objectiveof placing one or more strips 10 in or about the soft palate 12 regionis intended to provide required structural support for the tissue in amanner that reduces the instances of vibration of such tissues. So incertain embodiments, strips 10 of various desired shapes and sizes canbe employed to populate the area of one's soft palate 12 to dampenvibrational movement caused by the passage of air through the regionwhen asleep. In some individuals, the surface area of adhesive strips 10will be relatively minor as compared to others, who may requiresubstantially all of the soft palate 12 tissue area to be covered toachieve relief from sore throat.

FIG. 9 illustrates a strip applicator 24 for placing a sore throat strip10 properly on the soft palate 12. Preferably the strip 10 (or strips,whether layered, certain portions more dissolvable than others, etc.)are positioned on a person's soft palate 12. This can be achieved via aperson's fingers or through the use of an applicator 24 (otherwisedescribed and illustrated.) The strip 10 is particularly suited todelivery of ingredients having activity in relation to the mucosa of thethroat, in particular at the soft tissue 12 in the pharyngeal region ofthe back of the throat, to keep the pharyngeal membranes moist andlubricated. The strip 10 is conformed as a relatively thin planarstructure to facilitate desired rates of inter-oral dissolution. Forexample, in certain embodiments, a single strip 10 may be preferably nomore than about 150 micron thick, more preferably in the range 100-400micron thick, and in other embodiments may be over 500 microns inthickness. In other embodiments, however, the ability to layer strips 10on top of one another provides for the manufacture and availability ofstrips 10 of more traditional thickness, such as those for example ofthe breath strips of Listerine, etc.

Reference herein to a strip 10 is to any soluble prolonged releasepresentation of the composition which is conformable and is adapted tolie in a subject's mouth without causing obstruction or interfering withbreathing, talking or swallowing or the like, or to conform to thesurface of a subjects open skin or wound. Preferably the strip 10comprises a flexible film or the like. In use, the strip 10 to be placedin a subject's mouth is intended to be placed at the back of the throat.

Components that can be included in strips 10 or associated with strips10 in the various ways described herein include agents that may includeadditional active ingredients, including a plurality of activeingredients having an activity in relation to a particular condition orthe throat or throat disorder, oral conditions, or open skin or woundhealing or repair agents and/or active ingredients having other desiredactivity.

In still other embodiments, the use of additional ingredients mayprovide for chemical binding, and for example for the use of liposometechnology, can be employed. In some embodiments of the invention a partor all of the active ingredients are encapsulated within encapsulationstructures selected to provide the desired degree of adhesion to themucous membranes of the throat, and adapted to release the activeingredients slowly over time in situ. These encapsulation structures maybe distributed within the base material in the strip 10 composition. Inone embodiment, the encapsulation structures comprise multilamellarmicroparticles.

The strips 10 preferably have a surface that is anti-microbial innature, such that such strips 10 assist in reducing the surface area inthe mouth where noxious odors may arise due to the proliferation of foulsmelling agents produced by bacteria that can survive in one's mouth.With possible breath freshening components added to the strip 10,morning breath and bad breath issues would be addressed. One aspect ofthe present invention is directed to the novel combination of aspecifically surface structured bioadhesively attachable, and in apreferred embodiment, dissolvable, strip 10 of material that persists inthe mouth for at least one hour and preferably at least about 3 hours,so as to stiffen the tissue of the throat, specifically the soft palate12. The ability to defeat the proliferation of bacteria in a person'smouth can significantly decrease the occurrence of so-called “morningbreath”.

Other embodiments employ differences in visual appearance to determinewhether a strip 10 patch is placed properly; whether certain desired orundesired bacteria are present in the mouth, etc, and such effectivemeans for determining the same include a film, coating or patch thatincludes one or more of the following characteristics: reflectance,retroreflectance, fluorescence, photoluminescent light transmission,color, tinting strength, and whiteness. In certain embodiments, themethod may also assist in the detection of whether a person has acertain medical condition, such as strep throat. Thus, in oneembodiment, the strip 10 patch changes color, expresses bioluminescence,etc. if there is strep bacteria present in a predetermined amount.

Preferably, a hydrophilic pressure-adhesive hydrogel is employed thathas desirable characteristics. In one embodiment, a hydrophobicpressure-sensitive adhesive or bioadhesives is used to provide desiredcontrol of tack, adhesive and water sorption properties required foroptimal application mucosal tissue. U.S. Pat. No. 5,166,233 to Kuroya,et al. is incorporated herein by this reference for suitable adhesivesin this regard. U.S. Pat. No. 6,552,024 to Choi is likewise incorporatedherein in its entirety by this reference, as is U.S. Pat. No. 7,906,140to Bromley, et al.; U.S. Pat. No. 6,803,420 to Cleary et al.; U.S. Pat.No. 7,984,714 to Hausmann et al.; U.S. Pat. No. 7,276,246 to Zhang; U.S.Pat. No. 5,578,315 to Chien et al.; U.S. Pat. No. 7,470,397 to Meathrelet al. U.S. Pat. Publication No. 2011/0033542 to Myers, et al.; U.S.Pat. No. 7,138,135 to Chen; U.S. Pat. No. 7,441,559 to Nelson.

Thickness of strips can relate to dissolution time especially if certainformulae are used. Incorpoarated herein by this reference are thefollowing with respect to strip production: wet cast monolayer filmcompositions for pharmaceutical and vitamin delivery are disclosed inFuchs et al. U.S. Pat. No. 4,136,162; Schmidt discloses bilayer filmcompositions for pharmaceutical and food uses in U.S. Pat. No.4,849,246, and Leung U.S. Pat. No. 6,923,981, Fuisz et al. US20080075825, 20090098192 to Fuisz, Slominski et al US 20060207721,Fankhauser et al, US 2007/0202057, Laskey U.S. Pat. No. 1,492,600, Repkaet al U.S. Pat. No. 6,375,963, Schiraldi; 20140065218 to Lang, et. al.,U.S. Pat. No. 6,072,100, Yang et al. U.S. Pat. Nos. 7,357,891 and7,425,292, and Pharmaceutical Extrusion Technology, edited by IssacGhebre-Sellassie and Charles Martin (2007) also incorporated in theirentireties by this reference. Also, for purposes of written descriptionand enablement of the various embodiments of the present invention, thefollowing published applications and issued patents are incorporatedherein by this reference in their entireties: U.S. Pat. Nos. 7,067,116and 7,648,712 to Bess, et al.; U.S. Pat. No. 7,632,525 to Dodds, et al.;U.S. Pat. No. 6,502,574 to Stevens, et al.; 20050159637 to Nelson etal.; U.S. Pat. No. 7,845,356 to Paraschac et al.; U.S. Pat. No.7,824,588 to Yang et al.; 20090098192 to Fuisz; U.S. Pat. No. 7,500,484to Nelson; Fentanyl compound-containing edible patch to be applied tooral mucosa, to Furusawa et al.; U.S. Pat. No. 7,566,310 to Badr et al.;U.S. Pat. No. 5,190,053 to Meer et al.; Schmidt U.S. Pat. Nos. 6,748,951and 6,467,485; 20110009834 to Asmussen; U.S. Pat. No. 4,136,145 toFuchs, et al. Various bioadhesive compositions comprising poly(acrylicacid) are described, e.g., in WO 98/22097; EP 410,696; U.S. Pat. No.5,643,603; U.S. Pat. No. 4,915,948; U.S. Pat. No. 5,895,804 and U.S.Pat. No. 6,284,235, U.S. Pat. No. 7,143,709; U.S. Pat. No. 7,666,502;and U.S. Pat. No. 7,579,078. U.S. Pat. No. 7,650,848; U.S. Pat. Pub. No.20060188813 to Shimada all of which are incorporated herein by thisreference.

In one embodiment, the strips can comprise collagen or other tissuegrowth enhancing material to further the stiffening of the soft palateso as to reduce the occurrence of vibration when a person is sleeping.Collagen allows for the tissue in growth (tissue engineering). Thecollagen can be in many types and forms, or in combinations thereof. Forexample, collagen can be Type I, II or III. Collagen can be native,denatured or cross linked. The various types and forms of collagen aredescribed generally in Methods in Enzymol. (1982) 82:3-217, Pt. A, thecontents of which is incorporated by this reference. For example,collagen can be produced from animal derived tissues such as bovinehides, human tissues such as cadaver skin or human cell cultures orthrough recombinant methods.

For sore throat applications, the strip as described may also be loadedwith analgesics and pain relievers in addition to the other activecomponents described herein, thus providing a person with the ability tofight the infection and inflammation of tissue in the back of theirthroats while also achieving pain relief while doing so. In certainpreferred embodiments of the present invention, the wood sugar xylitolis provided in the strip that attaches or adheres to the back of aperson's throat.

Streptococcus pyogenes is a frequent colonizer of the respiratory tractmucosal surface, causes a variety of human diseases. Lactobacilli havebeen demonstrated to colonize the respiratory tract. Competition with acombination of Lactobacillus species reduced GAS adherence to host cellsmost efficiently. The effector molecules released from Lactobacillusstrains affecting the virulence phenotypes of pathogens is believed tobe useful in the development of a new generation of therapeutics. S.pyogenes produces a wide array of virulence factors, enabling it toadhere, invade, and spread within the human host. One aspect of thepresent invention relates to the impairment or deletion of suchvirulence factors to provide a bacteria that may competitively competewith other strains, thus providing a way for a person to populate theiroral cavity with a less infectious bacteria and thus, avoid sorethroats.

Adherence of Streptococcus pyogenes to human epithelial pharangeal andoral mucosal cells can be inhibited by oligosaccharides, preferablyassociated with one or more strips as described herein prior toplacement of the stirps in a person's throat. In U.S. Pat. Nos.5,002,759 and 5,095,106, which are incorporated by reference,oligosaccharide compositions and methods are described that inhibit theadhesion of S. pyogenes on pharyngeal and oral mucosa. The inhibitoryactivity of these oligosaccharides can be substantially enhanced bycoupling them with a carrier to make glycoconjugates. Thus, in variousembodiments of the present invention, in addition to the structuralfeatures of the strips as disclosed herein that have anti-bacterialproperties, preferred embodiments also include one or both ofoligosaccharides and glycoconjugates. Oligosaccharides may be selectedfrom the group consisting of A-tetrasaccharide, B′-sialyllactose,lacto-N-tetraose, B-trisaccharide, fucosyllactose, lacto-N-neotetraoseand gangliotetraose. Preferably the oligosaccharide is conjugated tohuman serum albumin or bovine serum albumin. Specific examples furtherinclude the oligasaccharide—conjugates Gal 1-3 Gal N-acetyl-Human SerumAlbumin, lacto-N-fucopentaose 1,1,1-Human Serum Albumin, Galbeta 1-4galactose N-acetyl beta 1-0-para amino phenyl Human Serum Albumin.

Bioadhesion, in particular mucoadhesion, has been of interest for thedevelopment of controlled drug delivery systems to improve buccal andoral administration of drugs. Carboxylated polymers, such aspoly(acrylic acid) and crosslinked poly(acrylic acid), are known to beeffective as mucoadhesives (hereinafter bioadhesive compositions).Various bioadhesive compositions comprising poly(acrylic acid) aredescribed, e.g., in WO 98/22097; EP 410,696; U.S. Pat. No. 5,643,603;U.S. Pat. No. 4,915,948; U.S. Pat. No. 5,895,804; 20070218114 to Duggan;and U.S. Pat. No. 6,284,235, all of which are incorporated herein bythis reference for particular embodiments of the invention.

Other embodiments are directed to an oral strip having a preloadedpopulation of bacteria residing thereon (or that can be cultured on thestrip after triggering the growth of the bacteria pre-placed thereon)such that there is competitive inhibition of other bacteria, namely S.pyogenes, such that sore throats are avoided or at least lessened inseverity.

The strips of the present invention may be configured for inter-oraladministration and may contain either an anti-bacterial surface to whichfew, if any bacteria attach, or alternative strips have pre-determinedpopulations of “friendly bacteria” thereon, such that the surface areafor S. pyogenes to grow is thus limited, effecting the prevention of asore throat and therefore providing a method for the preparation thereofand use thereof in alleviating throat conditions or throat disorders. Inyet other embodiments, thin films are adapted for attachment to themucosal membrane, in particular to the back region of a person's throatwhere bacteria reside, and in particular bacteria that cause disease andresult in a person experiencing a sore throat, with such thin filmshaving an effective amount of xylitol. It has been found that bacterialresistance is one of the main problems in controlling recurrentinfections and the improper use of antibiotics has permitted manymicroorganisms to adapt and become resistant to treatment. A better wayof controlling this phenomenon is through bypassing the bacteria'sadaptive qualities altogether.

The microbiota prevents colonization with pathogenic bacteria andrepresents an important first line of defense. Mechanisms describing theprobiotic effects of Lactobacillus strains include upregulation of mucinproduction in the host cells, interference with host pattern recognitionreceptors, competition for essential metabolites, production ofantibacterial molecules, and co-aggregation between the bacteria of themicrobiota and invading pathogenic bacteria, leading to interferencewith pathogen adherence to host cells. This later ability to coaggregatewith S. pyogenes (using certain strains of lactobacillus) forms oneembodiment of the present invention and is responsible for the abilityto thwart sore throat to progress in a human when a strip of the presentinvention is applied at a time prior to full S. pyogenes adherence tomucosal tissue. Lactobacillus components mediating adherence inhibitionare known by those of skill in the art and may be employed in thecontext of strips as described herein so as to inhibit the adherence ofdifferent pathogens, but especially S. pyogenes in the context of sorethroat infections. Colonization with Lactobacillus species impairs GASpathogenicity at different stages of infection, both by reducing theadherence at earlier stages and by affecting the viability afterprolonged incubation and attenuating the hemolytic activity. In otherembodiments, phytochemicals are employed as alternatives to theclassical antibiotics currently used for the treatment of streptococcalinfections. Preferred phytochemicals demonstrate direct bactericidal orbacteriostatic effects, such as: (i) prevention of bacterial adherenceto mucosal surfaces of the pharynx, skin, and teeth surface; (ii)inhibition of glycolytic enzymes and pH drop; (iii) reduction of biofilmand plaque formation; and (iv) cell surface hydrophobicity. The use ofother factors, such as dispersin B, or glycoside hydrolase produced bythe periodontopathogen A. actinomycetemcomitans, may be employed toinhibit biofilm formation and disperse biofilms formed by severalbacterial species.

The present invention includes a method that reduces the duration,frequency, or severity of sore throat disease. In certain embodiments,strips of the present invention provide a barrier-forming surfaceoverlying the mucosa and preferably having the anti-bacterial surfacesuch that S. pyogenes populations on the mucosal surface is thwarted andsuch surface is either antimicrobial due to its physical conformationand/or is active to kill or neutralize microorganisms in the oralcavity.

The naturally occurring sugar Xylitol is a natural sweetener and has ananti-adherence property that is believed to interfere with manymicroorganisms ability to cling to cell tissues. As bacterial infectionoccurs when bacteria adheres to tissues in a manner that permitscolonization and growth, the use of xylitol is believed to prevent thisaction and in the process, stave off bacterial infection. One problemwith prior art administrations of xylitol has been to provide xylitol ineffective concentrations, in the proper place (e.g. in contact withparticular tissue), and for an extended period time so as to achieve itsanti-bacterial abilities. Sprays and merely chewing gum containingxylitol have shown some benefits in terms of dental cavity preventionand in washing of nasal tissues. But the present invention is effectivein isolating the particular tissue most at risk of bacterialinfection—the back of one's throat—and focuses an effectiveconcentration of xylitol (as well as the many other agents and bacteriaas described herein) on such tissue for an appropriate and effectiveperiod of time so as to reduce the number of undesired bacteria thatwould otherwise exist on the tissue of one's throat. Because thebacteria are not allowed to infect, antibiotics are not needed incertain embodiments of the present invention.

While not bound by theory, it is believed that xylitol disperses anddisrupts biofilms and thus, in addition to its anti-adherence property,xylitol is able to help in the treatment of diseases where bacteria andother microorganisms are the causative agents. It is further believedthat xylitol is effective in dispersing yeast-born bacterialmicroorganisms and in controlling their growth. It is also speculatedthat xylitol is a glucose competitor that is able to inhibit glycolysis.

Because of its five-carbon sugar alcohol structure, xylitol isunsuitable as a source of energy for most oral micro-organisms, such asStreptococcus mutans. Yet, most S. mutans strains are, via the fructosephospho-transferase system, able to transport xylitol into the cell,where it is phosphorylated into xylitol-5-phosphate, which then has tobe expelled from the cell. This metabolically futile xylitol cycleconsumes energy stores of the cell and is thought to be responsible forthe inhibition of the growth of S. mutans observed both in vitro and invivo when exposed to xylitol. Because the bacteria are not killed,resistance is not as big a problem. Use of the strips of the presentinvention are suited for the treatment of appropriate infections andreduces the need for second and third generation antibiotics. In certainembodiments, the re-population of the mouth with a population ofbacteria that are considered to be more healthy than infectious bacteriais one aspect of many embodiments of the present invention. Due to itscrystalline structure, i.e., distinct single crystal, definitive form,and very dense nature, when added to a strip of the present invention,aqueous crystallized xylitol does not “dry” the strip out. Xylitol is apentitol and is used not only as a sweetener but also as a platformchemical for the production of industrially important chemicals. Oralbacteria thrive on certain carbohydrate molecules such as sucrose,glucose, fructose and other sugars but when they ingest xylitol, theycease proliferating and cease to adhere to human tissues. Deliveringxylitol via the strips of the present invention also provides otherbenefits, such as remineralization of teeth and reduction of plaque andhalitosis by stimulating saliva flow.

The present invention provides for a strip that can be adhered to themucosal membrane and preferably to a particular upper mouth portion of aperson's mouth that contains the bacteria that causes bad breath,promotes diseases, etc. The strip, when it dissolves, releases xylitolor a similar polyol. And there is a need to slow the rate of dissolutionto maintain therapeutic levels of xylitol or other polyol in the fluidsof the oral cavity over longer periods of time and this is achieved bythe strips of the present invention. Many causes lead to congestion andirritation of the exposed surfaces of the respiratory tract, especiallythe throat. The use of strips of the present invention, especially thoseformulated with a particular concentration of saline and with xylitol,are believed to significantly reduce and decrease snoring. Certainformulations of the strip, especially those that include particularsaline concentrations, are believed to pull fluid from the mucosa and atthe same time, flushes out germs, contaminants, and pollutants(pollen/dust/sand/soot/smoke, etc.) from the mucus membranes. Forexample, in particular embodiments, strips that are adapted to beadhered to the mucosal membrane include a preservative free hypertonicsaline at 2.3% to and including 2.7% w/v (preferably 2.4% to andincluding 2.6% w/v) salt is effective.

In one aspect, the invention is a strip having polyol molecules,particularly xylitol, with a reduced rate of dissolution in saliva andthat preferably dissolves much more slowly than substantially pure(greater than or equal to 98%) xylitol. Preferably, strips do notsubstantially swell when exposed to water. Strips may be formed bymelting the polyol and then cooling them until the polyol moleculescrystallize or by pressing powders of polyol crystals into a strip. Incertain embodiments, the dissolution time of the strip in a human mouthis, on average, more than 25 minutes more preferably, more than 1 hour,and most preferably, more than about 3 hours. To achieve slow release ofpolyol molecules, the strips may be formed with low water levels so thatthe polyol, preferably xylitol, particles do not dissolve readily orquickly. Thus, some embodiments include fine grains of xylitol with2.5%-6% carboxymethylcellulose (CMC) (by weight relative to the xylitol)incorporated into strips with insignificant amounts of water. Thelaryngeal/pharyngeal cavity is lined with a mucosa the essentialcomponent of which is the epithelium. The epithelium is the interfacebetween the human body and ingested substances and forms a complexphysicochemical barrier which, supplemented by the mucociliaryapparatus, constitutes the first defense against pathogens. Mucus coversthe epithelium and provides an additional protection for the mucosa, inwhich it forms a semi-permeable barrier that allows the exchange ofnutrients, water and gases but keeps out pathogenic germs. Mucus is aviscoelastic gel of complex composition which is continuously secretedby intraepithelial cells and salivary glands. The main components ofmucus are mucins, large and strongly charged glycoproteins which formthe structural framework of the mucosal barrier by cross-linking. Stripsof the present invention, in certain embodiments, are designed andadapted to adhere to the mucosal membranes (preferably buccal but alsocould be vaginal, rectal, etc.) to provide a slow release of effectiveamounts of polyols, and preferably xylitol, for a period of time incontact with such membranes for over about 1 hour, more preferably overabout 3 hours and even over 5 or more hours. In one embodiment, theinvention is directed to a thin film composition for administering anactive ingredient comprising a film layer, wherein the film layer had ananti-bacterial agent consisting essentially of xylitol; wherein saidthin film is adhesive to a mucosal membrane and is dissolvable over aperiod of no less than about 2 hours. Preferably the film strip weighsabout 10 to 80 mg per strip and includes xylitol having a particle sizeof about 10 to 400 mesh.

Still other embodiments include combinations of various herbal and sugarcomponents, such as xylitol and tomatidine in a mucosal adhesive stripthat achieves the combined functionality of those particularingredients, e.g. reducing bacteria and facilitating muscle tissuehealth.

To provide necessary and sufficient written disclosure and enablement ofthe various embodiments of the present invention, the followingreferences are incorporated by reference in their entireties: U.S. Pat.No. 9,017,718 to Tan; 20140065218 to Lang et. al.; U.S. Pat. Nos.6,599,883; 8,383,201; 5,158,789; 2007/0218114 to Sorousch; 2004/0136923to Davidson; U.S. Pat. No. 8,999,372 to Davidson; 2009/0196907 toBunick; 2009/0196908 to Lee; 2003/0124178 to Haley; 2007/0293587 toHaley; 2010/0285098 to Haley; 2006/0204591 to Burrell; U.S. Pat. No.7,087,249 to Burrelll; U.S. Pat. No. 6,210,699 to Acharya; U.S. Pat. No.8,865,211 to Tzannis; 2014/0199266 to Park; U.S. Pat. No. 6,599,883 toRomeo; PCT/US2008/080362 to Dussia; 2007/0218114 to Duggan; 2004/0136923to Davidson; 2011/0142942 to Schobel; 2004/0120991 to Gardner et al.;Fuchs et al. U.S. Pat. No. 4,136,162; 2004/0136923 to Davidson; U.S.Pat. No. 4,163,777 to Mitra; U.S. Pat. No. 5,002,970 to Eby, III;2004/0096569 to Barkalow et al.; 2006/0035008 to Virgallito et al.;2003/0031737 to Rosenbloom; U.S. Pat. No. 6,919,373 to Lam et al.;2005/0196358 to Georglades et al.; U.S. Pat. No. 3,832,460 to Kosti;2002/002057 to Battey et al.; 2004/0228804 to Jones, et al.; U.S. Pat.No. 6,054,143 to Jones; U.S. Pat. No. 5,719,196 to Uhari; 2015/0150792to Klingman; 2014/0333003 to Allen; 2014/0271867 to Myers; 2014/0356460to Lutin; 2015/0038594 to Borges; U.S. Pat. No. 6,139,861 to Friedmanand US pat. Publication No. 20140065218.

Another aspect of the certain embodiments of the present invention isdirected to a thin film mucosal layered strip that includes severallayers, and in one particular embodiment, at least four layers, with afirst layer comprising an odor impervious material, a second layer thatcomprises at least one encapsulated solvent, a third layer having asolvent absorbent material, and a fourth layer comprising an adhesive,wherein the solvent is encapsulated in a frangible enclosure and ispresent in an amount of at least about 0.5 ml. The solvent can includevarious compositions and chemicals or natural compounds, but includebreath freshening agents, lubricants, xylitol, medicines, crosslinkingagents, etc. Certain embodiments of such a layered strip include a colorchange indicator, preferably as part of one of the second layer and thethird layer. The strip may also include one or more odor reducingagents.

Still other embodiments include the use of a strip that has at least onecompartment or encapsulation area where a desired agent is provided thatcan be purposefully released at a given time while in the oral cavity.For example, provision of an analgesic encapsulated in a frangible shellthat is associated with the strip can be used to provide a person withthe ability to pop such shell and release analgesic when the painassociated with a sore throat develops. More importantly, treatmentagents can be encapsulated in such strips, such that antibiotics or coaggregation agents or LAB, etc. can be encapsulated in a manner thatthey can be released into the oral cavity at a time when the person sodesires and/or when the strip dissolves to a certain extent, e.g. whenthe walls of the encapsulating shell is worn thin enough to fracture torelease the agent(s). The manner in which a capsule can be fractured inorder to release its solvent contents is variable and will be understoodby those of skill in the art. Preferably, the capsule is constructed ina manner that it is sufficiently robust such that mere transport andpackaging of the strips containing such capsules does not cause anyleakage or breakage of such capsules. Instead, the design of capsules issuch that they are frangible with a considerable amount of force beingdirectly applied thereto once the strips are placed on a particularmucosal surface, such as on the soft palette of a human, such that theperson's tongue, when pressing against such capsule, can cause it tofracture to release the contents of the capsule. In other embodiments,two or more different materials may be released (such as a xylitolcontaining solvent and a color change agent) and a divider may beemployed that may comprise a membrane having one or more zones ofweakness, such as a declivity or score line, such that when a hollowbody comprising the encapsulated structure is manipulated, such as beingbent, pressed, crushed, flexed, or compressed along a zone of weakness,an opening is created in the divider, permitting the contents of a firstcompartment and a second compartment to mix. Such a hollow bodypreferably has an opening at a first end, and a frangible seal thatcloses the opening to retain the contents housed in the hollow body. Inone embodiment, the frangible seal comprises a thin membrane, forexample, thin films of plastic or biodegradable material. In otherembodiments, an absorbent material is also employed to retain thereleased solvent in a particular location for a desired period of time,which may include a semi-porous material, such as a sponge. When thefrangible seal is broken, the contents of the hollow body are releasedinto the absorbent material. The hollow interior of the solventcontaining member may define a reservoir for containing a liquidcomposition, such as the solvent, color change material, etc.

Preferably, a frangible seal is provided that is liquid-tight prior touse of the strip. The frangible seal is designed to preferably be weakerthan the seal at one end, thus when the solvent containing capsule ismanipulated, for example by squeezing, tongue manipulation, etc. itcauses the frangible seal to be broken, permitting the solvent or otherliquid material in the reservoir to flow out. A number and variety ofdesired substances may be employed in association with such an absorbentlayer via employment of a frangible capsule that can contain suchsubstance, especially in association with an adhesive portion of thestrip so that the substance can be administered to the desired site.Thus, such frangible capsules of the strip can be used in associationwith a capsule containing a wound healing substance, or a pain killer,an allergesic, a medicine, a growth promoting material, a muscletreatment gel, deodorant, etc. such that the affected area can becovered and then at a desired time, the capsule can be broken to releasethe desired pre-packaged substance or combination of substances. In oneparticular embodiment, the use of a capsule is employed that can containmore than one substance separated by frangible structures such that acombination of substances can be delivered in a desired sequence and ina particular position on a surface, such as a person's mucosal membraneor skin, so that the purposeful combination of such substances can beachieved in an easy fashion. The strips of the present invention, byvirtue of their encapsulated frangible structures, whether or notassociated with absorbent materials and barriers find various uses thatare accomplished in an easy, cost effective manner and enables one tocarry the devices with them for use outside of medical clinics, etc. Incertain embodiments, the breaking of one or more encapsulations thatcontain an anti-odor component, such as a breath freshener, acyclodetrin component to mask or eliminate certain odors, can be usedfor various mucosal adhesive encapsulated structures.

One aspect of the present invention is directed to a microorganism thatbinds to Streptococcus pyogenes, preferably such microorganism being alactic acid bacterium. In an especially preferred embodiment, themicroorganism or the analog, fragment, derivative, mutant or combinationthereof, belongs to the Lactobacillus genus and in other preferredembodiments, the microorganism or analog, fragment, derivative, mutantor combination thereof does not have the ability to coaggregate withcommensal microorganisms of the mucous membranes. Such a microorganismis preferably selected from the group comprising Lactobacillus lactis,Lactobacillus helveticus, Lactobacillus jensenii, Lactobacillusacidophilus, Lactobacillus bulgaricus, Lactobacillus amylovorus,Lactobacillus delbrueckii, Lactobacillus casei, Lactobacillus crispatus,Lactobacillus gasseri, Lactobacillus johnsonii, Lactobacillus paracasei,Lactobacillus pentosus, Lactobacillus rhamnosus, Lactobacillus curvatus,Lactobacillus plantarum, Lactobacillus brevis, Lactobacillus buchneri,Lactobacillus fructivorans, Lactobacillus hilgardii, Lactobacillusfermentum, Lactobacillus reuteri, Lactobacillus viridescens,Bifidobacterium bifidum, Lactobacillus ingluviei or analogs,derivatives, fragments or mutants thereof.

Preferred products for application of various compounds and substancesof the present invention include, in addition to the preferred use ofstrips as described herein, toothpaste, mouth washes, gargle solutions,nose sprays, mouth sprays, throat sprays, chewing gum, hydrogel, creams,etc.

The preferred composition is for topical prophylaxis or treatment ofmicrobial diseases of inflammatory diseases of the oral cavity. It ispreferably for use in prevention or treatment of microbial diseases ofthe oral cavity but can also be used for topical prevention or treatmentof microbial diseases or inflammatory diseases, preferably microbialdiseases or inflammatory diseases of the skin. In some embodiments, thecomposition may be used to produce an antimicrobial additive for topicaltreatment of inflammations in the oropharyngeal space and may be usedprophylactically and may be applied orally, sublingually or buccally.

The preferred lactic acid bacteria coaggregates specifically with thepathogenic bacteria Streptococcus pyogenes. As adhesion is an essentialfirst step in bacterial pathogenesis, one aspect of the presentinvention is focused on adhesion as a way to prevent sore throatinfections. In various embodiments, S. pyogenes is coaggregated in theoral cavity, so that binding to epithelial cells cannot take place fromthe beginning. In other embodiments, the coaggregation is accomplisheddue to the provision of a strip that adheres to the top most portion ofa person's mouth where certain bacteria are provided to coaggregate withS. pyogenes. Typically, the resulting cell aggregates are swallowed withsaliva and the Streptococcus pyogenes cells are killed duringgastrointestinal passage. Certain preferred bacteria used in the presentinvention are found on the skin flora and are able to bind to orcoaggregate with the pathogenic bacterium Streptococcus pyogenes.Preferred lactic acid bacteria coaggregate with Streptococcus pyogenesor have adhesive properties with respect to these bacteria. Thecoaggregation of Streptococcus pyogenes, is not inhibited either insaliva or in the presence of sugars.

It is known that coaggregation processes are generally inhibited by highsugar concentrations, but certain lactic acid bacteria will coaggregatewith Streptococcus pyogenes, even at high sugar concentrations such asthose occurring in saliva.

Those skilled in the art are aware that Streptococcus pyogenes is alsoknown as a pathogenic wound organism, so it is especially advantageousthat the coaggregation capability of the preferred microorganisms is notlimited to the oral cavity but instead can also be applied to areas ofthe skin. Preferred microorganisms can also be used on skin, where itwill also coaggregate with Streptococcus pyogenes.

Certain bacteria employed herein specifically coaggregate the pathogenicbacterium Streptococcus pyogenes, but do not bind any other commensalmicroorganisms. In particular embodiments, particular cultures areemployed and a CRISPR-Cas system is used to modify such cultures toremove certain virulence factors and/or to promote their survival in theoral cavity. The CRISPR-Cas system is preferably employed to excise thevirulence factors of one or more of the following bacteria:Lactobacillus lactis, Lactobacillus helveticus, Lactobacillus jensenii,Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillusamylovorus, Lactobacillus delbrueckii, Lactobacillus casei,Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus johnsonii,Lactobacillus paracasei, Lactobacillus pentoses, Lactobacillusrhamnosus, Lactobacillus curvatus, Lactobacillus plantarum,Lactobacillus brevis, Lactobacillus buchneri, Lactobacillusfructivorans, Lactobacillus hilgardii, Lactobacillus fermen turn,Lactobacillus reuteri, Lactobacillus viridescens, Bifidobacteriumbifidum, Lactobacillus ingluviei and preferably selected from the groupcomprising the following microorganisms deposited with the GermanCollection for Microorganisms and Cell Cultures where they are numberedas DSM 25972, DSM 25987, DSM 25988, DSM 25989, DSM 25973 and have beenin accordance with the Budapest Treaty regarding InternationalRecognition of the Deposition of Microorganisms for the purpose ofpatent deposition.

In a preferred embodiment of the invention, strips containing effectiveamounts of these bacteria are provided that are attached to the softpalate region of a person's mouth, thus providing a prophylactic productto prevent the advancement of sore throat. In other preferredembodiments, an extract of cranberries is provided as it is believedthat coaggregation of Streptococcus pyogenes is substantially moreefficient when a solution of cranberries is present. Through theformation of coaggregates, Streptococcus pyogenes is prevented fromcolonizing and invading cells of the throat area in particular. TheStreptococcus pyogenes cells, in particular their cell surface, arebelieved to be masked by the lactic acid bacteria, in particularlactobacillus cells, so that the Streptococcus pyogenes cells arepreferentially no longer able to bind to the epithelial cells of theskin and mucous membranes. Thus, one aspect of the present inventon isdirected to the competitive inhibition of S. pyogenes growth in anindividual's mouth by the administration of certain Lactobacillusmicrobes to defeat further adhesion and disease progression.Inflammation reactions are prevented by the hindered binding ofStreptococcus pyogenes to the epithelial cells of the skin and mucousmembranes.

The prevention of the binding of Streptococcus pyogenes at a very earlystage of a sore throat to epithelial cells and to promote purposefulcoaggregation of Streptococcus pyogenes in the oral cavity is believedto provide an effective non-antibiotic way to defeat the tremendous painand sickness associated with this long felt but unsolved health problem.

The coaggregatoin products can be removed mechanically, for example, byrinsing them off via a mouth wash, etc. so that the number of pathogenicmicroorganisms is reduced.

Another property of the lactic acid bacteria according to the inventionis the capability to inhibit binding to host cells by Streptococcuspyogenes in that these cells, which are already present in planktonicform, are specifically coaggregated and then washed away as aggregates.These pathogenic bacteria can no longer colonize and invade biologicalsurfaces due to this coaggregation and therefore they also cannot causeany diseases. Therefore in the sense of the present invention, thephrase “inhibiting the binding to host cells (oropharyngeal cells) byStreptococcus pyogenes” is to be understood to refer in particular tothe property of the lactic acid bacteria according to the invention tointeract with Streptococcus pyogenes, i.e., to bind to them or otherwiseinfluence them in such a way that they can no longer bind tooropharyngeal cells.

In certain embodiments, CRISPR-Cas is used to modify S. pyogenes so thatit lacks the ability to adhere to epithelial cells and also to be ableto coaggregate to lactobacillus species in a substantially greaterdegree than wild type S. pyogenes. In such a manner, one achieves highcoaggregation activity in human saliva and the resulting aggregates ofStreptococcus pyogenes are stable and thus can be removed by simplerinsing or swallowing. In particular, the coaggregation efficiency canbe increased significantly in the presence of cofactors (EDTA, MgCl2,CaCl2, SDS). To determine which particular lactobacillus species can beemployed, one of skill in the art will appreciate how to determine if aparticular lactobacillus strain is able to coaggregate with one or moreof S. mutans; S. mitis, S. salivarius, S. gordonii and S. sanguis. If itcannot, then such lactobacillus is a candidate for a coaggregationbacteria with S. pyogenes. Coaggregation, the specific recognition andadherence of different microbial species, is thought to enhance biofilmformation. Nasopharyngeal bacteria belonging to the human opportunisticpathogen archetype showed the least number of coaggregations. Thus, incertain embodiments, the present invention is directed to employingCRIPR-Cas systems to enhance the ability of pathogenic organisms, inparticular S. pyogenes, to coaggregate with other bacteria, preferablyother lactobacillus bacteria, and more preferably those described hereinwith particular deposit information.

Thus, several aspects of the present invention are directed to the useof particular LAB to inhibit or modulate one or more of adhesion,invasion and virulence expression to facilitate clearance of a pathogen,and in particular to advance coaggregation with S. pyogenes withoutnecessarily killing such pathogen.

Other aspects are directed to the pre-colonization of a person's oralcavity with preferred LAB to reduce adhesion of epithelial cells topathogenic microbes, and especially S. pyogenes. It is further believedthat use of LAB having superior adherent properties (as it relates toadherence to epithelial cells) is effective in competitively inhibitingS. pyogenes infection and that such LAB also displace pathogens bindingto epithelial tissues. Thus, effective colonization of LAB to a person'sthroat tissues, such as via the use of the strips as described herein(especially those impregnated with LAB and an effective growth media onthe strip for those LAB, is an effective way to achieve desiredcolonization. The further use of strips having antibacterial surfacessuch that the strips discourage populations of S. pyogenes achievingcritical numbers to promote a continuance of sore throat is yet anotheraspect of the present invention. Again, it believed that the LABcoaggregation with S. pyogenes is one of the principal reasons theprogression of sore throat does not occur when effective amounts of LBare administered to one's throat. The strip embodiments of the presentinvention are believed to be very effective in providing such LABpopulations in a continued format as the regular continued swallowing ofLAB otherwise could rid the oval cavity of LAB that would otherwise bepresent to coaggregate with S. pyogenes. By having the LAB effectivelypresent on tissue that would otherwise be adhered to by S. pyogenes, theavoidance of major sore throat infections is achieved. Thus,coaggregation of lactobacilli with pathogens is one mechanism that canexplain adhesion inhibition.

Other LAB that may be employed in various embodiments include thefollowing: lactobacillus slaivarius CICC 23174; lactobacillus plantarumCGMCC 1.557, lactobacillus rhamnosus ATCC 53103, and lactobacillusacidophilus ATCC 4356. In other particular embodiments, the use of S.oralis and S. salivarius may be used in combination to inhibit growth ofS. pyogenes, with speculation being that S. salivarius may achive thisfeat via bacteriocin secretion. Epithelial cells are believed to beprotected from infection by S. pyogenes when a biofilm containing S.oralis and S. salivarius is applied, with S. pyogenes unable to adhereto such tissue, thus the individual is protected from the adherence,internalization, and cytotoxic effects of a sore throat.

Other aspects of the present invention involve the elimination of orreduction of the presence of certain bacteria that appear to enhance theability of S. pyogenes to adhere to epithelial tissues, one of suchbacteria being Moraxella catarrhalis. Thus, an effective reduction ofMoraxella catarrhalis by various means, such as by an antibiotic, can beused to reduce the chances of infection with S. pyogenes.

Popping capsules when one feels that their throat feels like it isgetting sore is one aspect of the present invention. The timeliness ofbeing able to address an imminent cellular interaction by providingmedications or beneficial agents directly to the tissue at issue bymerely having one's tongue cause a frangible vesicle, encapsulation,etc. to release a desired agent to contact with the tissue, is a novelway in which to effectively stop a biological process before itprogresses to a later stage, at which point the desired effect of theagent may not be efficacious. For example, when one believes that theyare feeling the onset of a sore throat, often described as a tickling oftheir throat, such individual can apply one of the strips of the presentinvention directly to the roof of their mouth—employing the mucosaladhesive nature of such strip. The strip may also include encapsulatedpockets filled with beneficial agents so that breakage of such capsules,preferably by action of one's tongue pressing against the capsule intothe roof of the person's mouth, causes the capsule to break, thusreleasing the agents inside. Such agents can include, for example,beneficial bacteria, saline solutions of various strengths, antibiotics,co-aggregation agents, etc.

In still other embodiments, employment of technology described in U.S.Pat. No. 9,131,884 to Holmes is employed to achieve desired furthersteps to address communication of biological disease status to a thirdparty and in particular, the presence of a sore throat in a human. Forexample, in certain embodiments, a medical device is associated with amucosal strip that comprises a microarray having a bioactive agentcapable of interacting with a disease marker biological analyte and areservoir having at least one therapeutic agent, with the device able torelease the therapeutic agent(s) from the medical device. In certainembodiments, at least two microchips with a microarray scanning deviceadapted to obtain physical parameter data of an interaction between thedisease marker biological analyte and the bioactive agent is employed. Abiometric recognition device is configured to compare the physicalparameter data with an analyte interaction profile. The therapeuticagent releasing device controls the release of the therapeutic agentfrom the reservoir. The interface device facilitates communicationsbetween the microarray scanning device, biometric recognition device andthe therapeutic agent releasing device. An energy source to power themedical device can take several forms, including biologically activatedbatteries that are preferably associated with the strip.

Thus, in certain embodiments, sugar is used as a source of energy,notably glucose that is converted into different sugars via an enzymaticcascade to provide necessary energy to create an electrochemicalgradient. This, in turn, is used to power an enzyme that synthesizesadenosine triphosphate (ATP). In contrast to natural catabolic pathwaysfor cellular glucose oxidation, a preferred embodiment does not rely onATP as an energy carrier. Instead, two redox enzymes oxidize glucose,generating reduced nicotinamide adenine dinucleotide (NADH) as the sugaris broken down. Another series of enzymes (as many as ten additionalenzymes) further breakdown the sugars and feed them back to the redoxenzymes to produce more NADH, with water and carbon dioxide being theonly by-products. NADH is a reducing agent and acts as an electronshuttle that carries electrons in living cells from one molecule toanother. NADH first transfers the electrons stripped from the glucose toa mediator with the help of an enzyme. The mediator then delivers theseelectrons to the battery's electrode, rendering it available to power anelectronic device. Such a battery mimics the way a living cell transferselectrons from one molecule to another to generate power, it runs onrenewable sugars, and has a high-energy storage density, rechargableproviding an additional sugar solution. Malodextrin—a polymer made up ofglucose subunits—may be employed together with particular differentenzymes able to strip electrons from a single glucose molecule, thusharnessing the generated energy to power an electrical device. The useof such device, incorporated into the strip as otherwise describedherein, but especially those that have at least two of the followingcharacteristics (LAB eluting structures; CRISPR-Cas system modified LABto enhance coaggregation with S. pyogenes; inclusion of ananti-bacterial structural surface (see FIG. 2), etc.) can then be usedto communicate the status of a person's health to a third party due tothe energy producing system as described herein.

In various embodiments of the present invention, bacterial species areable to use various energy sources, including light and diverse organicand inorganic chemicals, for growth and metabolism. These energy sourcesare used to produce an electrochemical gradient that provides anelectron donor for metabolism and allows maintenance of a membranepotential and proton motive force. The energetics of living systems aredriven by electron transfer processes in which electrons are transferredfrom a substrate, which is thereby oxidized, to a final electronacceptor, which is thereby reduced. In certain embodiments, it ispossible to control metabolism by linking biochemical processes to anexternal electrochemical system, with such linking of biochemical andelectrochemical systems permitting the use of electricity as a source ofelectrons for biotransformation reactions. A reversiblebiochemical-electrochemical link allows for conversion of microbialmetabolic and/or enzyme catalytic energy into electricity.

While specific embodiments and applications of the present inventionhave been illustrated and described, it is to be understood that theinvention is not limited to the precise configuration and componentsdisclosed herein. Various modifications, changes, and variations whichwill be apparent to those skilled in the art may be made in thearrangement, operation, and details of the methods and systems of thepresent invention disclosed herein without departing from the spirit andscope of the invention. It is important, therefore, that the claims beregarded as including any such equivalent construction insofar as theydo not depart from the spirit and scope of the present invention.

What is claimed is:
 1. A bioadhesive strip for treating sore throat in ahuman being, comprising: a solid strip having a first and second side,said first side having a surface comprising a pattern defined by aplurality of spaced apart features each having at least one microscaledimension and having at least one neighboring feature having asubstantially different geometry, wherein an average spacing betweenadjacent ones of said features is between 0.5 and 5 microns in at leasta portion of said surface, the first side having a bioadhesive that isadapted to bind to a mucosal membrane for at least 1 hour while inside aperson's mouth, wherein said strip is sized to extend over a majority ofthe soft palate, and wherein said strip includes one of an analgesic,and a lactic acid bacteria that coaggregates with S. pyogenes, andwherein a CRISPR-Cas or Cfp1 system is employed to silence or to deleteat least one virulence factor of S. pyogenes.
 2. The strip of claim 1,wherein said strip includes at least one polymer selected from the groupconsisting of pullulan, hydroxypropylmethyl cellulose, hydroxyethylcellulose, hydroxypropyl cellulose, polyvinyl pyrrolidone, carboxymethylcellulose, polyvinyl alcohol, sodium alginate, polyethylene glycol,tragacanth gum, guar gum, acacia gum, arabic gum, polyacrylic acid,methylmethacrylate copolymer, carboxyvinyl polymer, amylose, highamylose starch, hydroxypropylated high amylose starch, dextrin, pectin,chitin, chitosan, levan, elsinan, collagen, gelatin, zein, gluten, soyprotein isolate, whey protein isolate, casein and mixtures thereof. 3.The strip of claim 1 wherein said strip has an analgesic encapsulatedinside a frangible capsule that may be broken by a person pressingagainst said strip with the person's tongue.
 4. The strip of claim 1wherein said strip is non-dissolvable in a person's mouth.
 5. The stripof claim 1 wherein said strip is dissolvable in a person's mouth withina period of 3 hours.
 6. The strip of claim 1, wherein the stripcomprises at least one encapsulated feature.
 7. The strip of claim 1,wherein said strip further includes at least 200 mg of xylitol.
 8. Thestrip as set forth in claim 1, wherein said strip comprises Prevotellabacteria.
 9. A bioadhesive solid strip for treating sore throat in ahuman being, comprising: at least one surface of said strip having apattern defined by a plurality of spaced apart features each having atleast one microscale dimension and having at least one neighboringfeature having a substantially different geometry, wherein an averagespacing between adjacent ones of said features is between 0.5 and 5microns in at least a portion of said at least one surface, said striphaving a first and second side, the first side having a bioadhesive thatis adapted to bind to a mucosal membrane for at least 1 hour whileinside a person's mouth, said strip having a length dimension of between0.5 and 2 cm; a surface area of 0.25-1.5 inches; and a weight of atleast 30 mg.
 10. The strip of claim 9, wherein the strip comprises S.pyogenes modified by a CRISPR-Cas system to reduce one or more virulencefactors.
 11. The strip of claim 9, wherein the strip comprises S.pyogenes that have been modified to render ineffective virulence factorsin a manner effective to avoid sore throat progression.
 12. The strip ofclaim 9, wherein the strip comprises lactic acid bacteria that populatethe strip and that are specifically able to coaggregate with S.pyogenes.
 13. The strip of claim 9, wherein the strip is dissolvable ina person's mouth after one hour.
 14. The strip of claim 9, wherein thestrip comprises S. pyogenes that have been modified to remove or disableone or more virulence factors and wherein the S. pyogenes isencapsulated on the strip within a pouch or pocket.
 15. A bioadhesivesolid strip for treating sore throat in a human being, comprising: atleast one surface of said strip having a pattern defined by a pluralityof spaced apart features each having at least one microscale dimensionand having at least one neighboring feature having a substantiallydifferent geometry, wherein an average spacing between adjacent ones ofsaid features is between 0.5 and 5 microns in at least a portion of saidat least one surface, said strip having a first and second side, thefirst side having a bioadhesive that is adapted to bind to a mucosalmembrane for at least 1 hour while inside a person's mouth, said striphaving a length dimension of between 0.5 and 2 cm; a surface area ofbetween 0.25-1.5 square inches; a weight of at least 30 mg; and includesbacteria modified by a CRISPR-Cas or Cfp1 system.
 16. The strip of claim15, wherein the strip includes S. pyogenes that have been modified torender ineffective virulence factors in a manner effective to avoid sorethroat progression.
 17. The strip of claim 15, wherein the bacteriamodified by a CRISPR-Cas or Cfp1 system are lactic acid bacteria thatcoaggregate with S. pyogenes.
 18. The strip of claim 15, wherein saidstrip reduces the adhesion of S. pyogenes to an epithelial tissue of aperson.
 19. The strip of claim 15, wherein the strip has a thickness ofbetween 100-400 microns thick and includes one of bacterial and helminthcomponents.
 20. The strip of claim 15, wherein said strip has ananalgesic encapsulated inside a frangible capsule that may be broken bya person pressing against said strip with the person's tongue.